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DOI Bulletin Relative To the Certification Of Risk-Bearing Provider Organizations

In response to the Massachusetts health care payment reform law, Chapter 224 of the Acts of 2012, the Division of Insurance (“DOI”) issued a bulletin (2012-08: Rules for Carriers and Provider Organizations Relative to the Certification of Risk-Bearing Provider Organizations) outlining the obligations of provider organizations to submit a Transition Period Waiver application to DOI.

A provider organization that has an alternative payment contract with downside risk in effect as of November 4, 2012, and has net patient revenue of $5 million or more, must submit an application with DOI for a Transition Period Waiver by December 21, 2012. A provider organization that has net patient service revenue of less than $5 million shall have until March 1, 2013 to submit its application materials to DOI.

A copy of DOI Bulletin 2012-08 can be found at the following link . If you have any questions, please contact the Division of Insurance at (877) 563-4467 (Toll Free) or (617) 521-7794.